Provider First Line Business Practice Location Address:
1259 E PROSPERITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULARE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93274-8060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-688-5020
Provider Business Practice Location Address Fax Number:
559-688-5021
Provider Enumeration Date:
09/21/2007